Alain B. Labrique, PhD, MHS, MS · Alain B. Labrique, PhD, MHS, MS Hong Kong – June 2017 Director...
Transcript of Alain B. Labrique, PhD, MHS, MS · Alain B. Labrique, PhD, MHS, MS Hong Kong – June 2017 Director...
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Alain B. Labrique, PhD, MHS, MS
Hong Kong – June 2017
DirectorJHU Global mHealth InitiativeAssociate ProfessorDept. of International Health Johns Hopkins Bloomberg School of Public HealthDept. of Health Informatics, School of MedicineDept. of Community Medicine School of NursingChairWHO mHealth Technical Evidence Review GroupWHO Digital Health Guidelines Development GroupVisiting Professor, Xiamen University, Fujian, China
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The Mobile Phone “Revolution” - 2000-2017
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The World is Changing Rapidly
Euclidean map of 10 million of the 850 million Facebook users friend networks© Paul Butler, FB
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Untethered, yet connected: Diverse use of wireless and mobile technologies designed to improve
health research, health care services and health outcomes
mHealth
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• Connect People
• Compress Time
• Capture Information
• Competence & Confidence
mHealth 5c’s
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mHealth is not a single THING.Mobile tools can be used to strengthen
different parts of the health system.
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12 Common Applications of mHealth
Labrique et al. GHSP 2013
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What problem(s) are you trying to solve?
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INTERVENTIONOF KNOWN
EFFICACY
EFFECTIVECOVERAGE
mHealth should not be about the technology. Its a Health Systems Catalyst.
Jo Y, Labrique AB et al. PLOS One 2013brique AB et al PLOS One 2013
Shift focus from “Does mHealth work?” to “Does mHealth optimize what we know works ?”
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A A
A Clinical Perspective
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A Clinical Perspective
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The Technology Innovation Center
brings together clinicians, Health IT, and researchers to
create patient-centered medical
solutions.
JHU Technology Innovation Center
@JHMTIC [email protected]
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October 2016: WHO Launches “Evidence-based Guidelines for Digital Health Strategies” Process.
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Health System Adequacy
Provider Competence
and Accountability
Patient Knowledge and
Self-Efficacy
THREE LAYERS OFmHEALTH
STRATEGIES
• INFORMATION• DEMAND
CREATION• SUPPORT SYSTEMS
• WORK MANAGEMENT
• DECISION SUPPORT
• ENUMERATION• SURVEILLANCE
• SUPPLY CHAIN• STAFF AND
FACILITY PERFORMANCE MONITORING
• REFERRAL SUPPORT
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Apps apps everywhere…
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… including at Hopkins
We even have a review site!
iMedicalApps.comThe most widely
read of all medical app review sites, receiving over 400,000 page
views per month. Content is written
by a team of doctors and
medical students.
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• DON’T – think about “app X or Y” or specific programs
• DO – think about digital strategiesto resolve clinical + population health constraints / bottlenecks
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Empower patients to verify quality
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Leveraging the “Internet” of Things
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Text message reminders improve adherence by 62%
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Boksmati, N., Butler-Henderson, K., Anderson, K. et al. The Effectiveness of SMS Reminders on Appointment Attendance: a Meta-Analysis. J Med Syst (2016) 40: 90. doi:10.1007/s10916-016-0452-2
Text message reminders reduce missed appointments by 61%
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Take two apps and call me in the morning.
• FDA-Approved• Partnered with
Samsung (Apr. 19/17)• Integrated Artificial
Intelligence / MachineLearning
• Connects Patient ->Provider -> Device
• Patient Experience First
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CorrieHealth: A model to improve patient self-efficacy
corriehealth.com
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Examples like mActive, extendthe continuity of the clinical visit, by allowing patient engagement with their own post-discharge activity and ‘continued’ oversight by the clinical care team.
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Patient Education (mLearning)
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Text Messaging for Patient “Groups”Examples:
• Pregnancy• Smoking
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GOOD MORNING! THIS WEEK YOU
SHOULD BE PLANNING A
HEALTHY PREGNANCY
CHECKUP AT YOUR LOCAL CLINIC. BUZZ
800-223-2233 OR PCM FOR MORE
INFO - MAMA
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Mobile Video Directly Observed Therapy
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PoopMD+ for Biliary Atresia
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EPIC EMR Patient View App
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The Wired Patientsensor -
a device that detects or measures a physical property and records, or otherwise responds to it.
Sources: WisePill, AliveCore, iBGStar, iHealth, Fitbiti i i i
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Monitor changes in patterns, or respond to alerts
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Personal fitness & wellness goals
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New paradigms linking patients & clinicians“Medical charts, vitals, clinical images, scans and other critical information - all
in one place and easily accessible at a touch of a finger.”
Patient Solutions
WORKFLOW INTEGRATION
Provider Solutions
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Promising early data suggests impact
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Doctor-in-a-Tab®
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Mobile Academy for Frontline Health Workers
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Challenges
Extending Reach of Clinical Care to Populations: Screening, Post-discharge Follow-up, Home VisitsChallenges
• Community-basedenrolment &counseling
• Populationdenominator
• Scheduling &reminders
• Protocol adherence
• Linkages to care Referrals and Follow-up
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Open Smart Register Platform (OpenSRP)
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OpenSmartRegister mimics standard patient line-listings used by Community
Outreach Workers around the globe, with “smart” digital features…
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Program Mwana: SMS to reduce Infant HIV PCR Turnaround Time
(Median 46% Reduction in DAYS)
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Barrington et al. Malaria Journal 2010, 9:298http://www.malariajournal.com/content/9/1/298
Simple interventions = Significant Impact !
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Tools to Monitor Population HealthSAGES provides national-grade biosurveillance and outbreakdetection, using sophisticated tracking and predictive analytics to identify
unusual patterns of disease.
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DATA FOR NATIONAL PROGRAM & POLICY
USE
Population-level text message / “robocall” surveys to estimate risk factors 10
Countries
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Faster Networks, Cheaper “Tech”
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New frontiers!
Remote, Point-of-care Diagnostic tools
Breslauer D., et al. 2009 Mobile Phone Based Clinical Microscopy for Global Health Applications. PLoS ONE 4(7): e6320
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FDA is approving numerous “mobile” alternatives to clinical devices…
AliveCor ® - www.alivecor.comQualcomm: Sense4Baby http://mobihealthnews.com/9459/west-wireless-health-announces-sense4baby-prototype/
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Mobile-based Flow Cytometry
Ozcan Research Group (Nano-Bio Photonics / UCLA): Optical imaging techniques for point-of-care diagnosticsHongying Zhu , Serhan O. Isikman , Onur Mudanyali , Alon Greenbaum and Aydogan Ozcan Lab Chip, 2012, Advance Article
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Real-time geospatial data use for program optimization
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Machine learning and AI : Field potential of “big data”
• Dynamic, Learning Systems which:• Refine risk models as new outcomes are added• Task shift burden of data interpretation • Can be used for system optimization AND
health outcome tracking • Leverage META-DATA captured by devices
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Human-Centered Design
“…Human-centered design is about listening…. When we better understand the realities of people’s lives, we are able to design and
deliver solutions that are useful to them.” – Melinda Gates, May 20, 2015
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http://digitalprinciples.org/
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http://tinyurl.com/WHO-MAPS
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The M.A.P.S. ToolmHealth Assessment and Planning for Scale
To assess scalability by reviewing key considerations and activities
To plan for future activities after identifying areas of weakness
To improve on progress through scale
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mHealthEvidence.org / mHealthKnowledge.org
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Continue to grow the evidence base. Innovation
can be subjected to rigorous evaluation
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A pragmatic approach that promotes high-quality reporting of mHealth innovation research, across varied study designs to facilitate evidence synthesis and development of guidance
• Domain 1: Research Methodology Reporting• Domain 2: Essential mHealth (Technology, Functionality, Delivery) Reporting
Domain Description No.
Domain 1.1 General Reporting and Methodology Criteria 23
Domain 1.2 Quantitative Criteria 4
Domain 1.3 Qualitative Criteria 3
Domain 2 mHealth Criteria 14
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Which Design is Appropriate for Your ProjectAt THIS TIME ?
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Data Quality Assessment Process
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Degree to which the mHealth strategy changes the status quo INCREMENTAL CHANGE DISRUPTIVE INNOVATION
DIFF
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Thank [email protected] Twitter: @alabriqu
@jhumhealth
Draw inspiration from around the globeto understand what is “m”POSSIBLE